-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: This study was designed to evaluate the efficacy of definitive radiation therapy (RT) for invasive carcinoma of the vagina. METHODS: Twenty-six patients with invasive carcinoma of the vagina who received RT were studied retrospectively. The median age was 68 years. The pathologic subtype of vaginal carcinoma was squamous cell carcinoma in 24 patients, adenosquamous cell carcinoma in one patient, and adenocarcinoma in one patient. The distribution of clinical stage according to the International Federation of Gynecology and Obstetrics staging system was as follows: stage I, seven patients; stage II, 10 patients, stage III, seven patients; and stage IVA, two patients. Twenty patients received external beam radiation therapy (EBRT) combined with high-dose rate intracavitary brachytherapy (HDR-ICBT), and three received EBRT alone. The remaining three patients with stage I disease were given HDR-ICBT alone. The median dose was 50 Gy for EBRT, and 23 Gy for HDR-ICBT. Systemic chemotherapy was administered concurrently with RT to three patients. RESULTS: The median follow-up was 90 months. The initial rate of response to RT was 100%, and complete remission was attained in 21 patients (81%). The 5-year overall survival rate (OS) and the median survival time of the 26 patients were 57% and 97 months, respectively. The 5-year OS for the three patients who received HDR-ICBT alone was 100%. Severe toxicity occurred in three patients-grade 3 rectal hemorrhage in one, grade 3 cystitis in one, and grade 4 cystitis in one. CONCLUSIONS: Our results demonstrated that definitive RT with HDR-ICBT is effective for invasive carcinoma of the vagina, with acceptable toxicity.
International Journal of Clinical Oncology 02/2012; · 1.41 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We report three cases of anal canal squamous cell carcinoma treated with radiotherapy combined with S-1 and mitomycin C(MMC). During radiotherapy, MMC was administered as intravenous bolus injection at a dose of 10mg/m2 on day 1 and 29. S-1 was administered orally at a dose of 80mg/m2 on days 1-14 and 29-43. Total radiation doses ranged 55. 8-60 Gy to pelvic lesions. The rates of grade 3 toxicity were: neutropenia, 100%; leucopenia, 100%; anemia, 33. 3%; anorexia, 66. 7%. These adverse events were tolerated. All of the three cases showed complete response without recurrences. These results suggested that this treatment schedule was safe and effective for anal canal carcinomas.
Gan to kagaku ryoho. Cancer & chemotherapy 12/2010; 37(13):2941-3.
-
[show abstract]
[hide abstract]
ABSTRACT: This study aimed to assess the feasibility, efficacy and complication of hyperthermia-inclusive multimodality therapies for patient with inoperable Pancoast tumor.
Five patients with inoperable Pancoast tumor were treated with hyperthermia-inclusive multimodality therapies. They received thermoradiotherapy with/without chemotherapy. Radiation therapy was delivered using 10 MV X-rays with total dose of 68-70 Gy. In the latter half of the radiation therapy hyperthermia was performed for 2-4 sessions once a week with 8 MHz radiofrequency device.
For primary response, 4 tumors showed partial response to the treatment with the exception of 1 tumor who showed stable disease. Only one patient was with a short follow-up period (9 months), all other patients survived 3 years or more without recurrence. Of them, 2 patients were recognized with local recurrence at 38.7 and 42.7 months after treatment and died at 66.9 and 78.5 months after treatment. The other 2 patients are disease-free survivor for 4 and 5 years after treatment. No severe non-hematological toxicity was observed in each patient.
These data suggested that hyperthermia-inclusive multimodality therapies might be a promising approach for inoperable Pancoast tumor.
Lung Cancer 08/2008; 63(2):247-50. · 3.43 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to examine the clinical usefulness of cytokeratin 19 fragments (CYFRA 21-1) compared with squamous cell carcinoma (SCC) antigen in patients with esophageal cancer treated with radiation therapy.
Fifty-one patients with stage I-IV esophageal cancer were evaluated. CYFRA 21-1 and SCC antigen serum levels were measured at the start and the end of radiation therapy.
CYFRA 21-1 (> 3.5 ng/mL) and SCC antigen (> 1.5 ng/mL) before radiation therapy were elevated in 63% and 53% of the patients, respectively. The CYFRA 21-1 levels were significantly correlated with TNM stages, tumor depth and lymph node metastasis (P = 0.0003, P = 0.019 and P = 0.019, respectively), whereas no correlation was observed between SCC antigen and these factors. The values of CYFRA 21-1 in all patients who survived without recurrence were under the cutoff level at the end of treatment, but the values in all patients with locoregional recurrence were above the level. However, there was no significant correlation between SCC antigen level at the end of treatment and any clinical outcome.
The results suggest that the evaluation of CYFRA 21-1 would be useful not only for assessment before radiation therapy but also for monitoring after radiation therapy in the treatment for esophageal cancer.
Journal of Gastroenterology and Hepatology 05/2007; 22(5):715-9. · 2.87 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The treatment results of 84 patients with clinical stage I and II non-small cell lung cancer (NSCLC) treated with definitive radiation therapy (RT) alone at Gunma University Hospital from 1976 through 1989 were retrospectively analyzed. All patients were treated with 10 MV X-rays using anteroposterior parallel opposed fields. The total dose ranged from 60 to 80 Gy, except for one patient given 90 Gy with once-daily standard fractionation. The 2-and 5-year survival rates were 74% and 31% for 28 patients with stage I disease, compared with 40% and 19% for 56 patients with stage II, respectively (P < 0.05). Fifty-three patients with tumors less than 5 cm in diameter had an in-field progression rate of 14% at 2 years, in comparison with 38% of 31 patients with tumors greater than 5 cm (P < 0.05). The difference of survival rates for these two groups was statistically significant (P < 0.005). Ten patients given a total dose of 80 Gy or over had only 17% local progression at the time of last follow-up, however, they had not been alive beyond 3 years because they developed pulmonary insufficiency due to severe stenosis of the proximal bronchus. A multivariate analysis indicated primary tumor size as the only significant prognostic factor for survival. In conclusion, the tumor size was the most important factor not only for local control but also for distant failure. It was also suggested that the optimal radiation dose for medically inoperable stage I-II NSCLC ranged from 60 to 70 Gy with once-daily standard fractionation. Radiat Oncol Invest 1996;4:165–170. © 1996 Wiley-Liss, Inc.
Radiation Oncology Investigations 02/2007; 4(4):165 - 170.
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to clarify how physicians should interpret the answer "neither" to the single-question interview, "Are you depressed or not?"
Two hundred fifty-one patients with cancer were studied. The patients were directly interviewed, choosing one answer among these three: "Yes, I am depressed"; "No, I am not depressed"; or "Neither." After this, the patients completed the Hospital Anxiety and Depression Scale (HADS). The threshold of 11 or greater on HADS was used for adjustment disorder and major depressive disorder.
All patients could reply to the single question, but 10 patients did not complete HADS. Among 83, 81 and 77 patients who answered "yes," "neither," and "no," respectively, 75 (90%), 43 (65%), and 9 (12%) patients scored 11 or more on HADS. The mean score of HADS was 12.2 in patients who answered "neither," significantly higher than that of the "no" group (p < 0.0001) and significantly lower than that of the "yes" group (p < 0.0001).
Patients who answered "neither" frequently scored in a high enough range to warrant further investigation for adjustment or depressive disorder.
Journal of Palliative Medicine 08/2006; 9(4):861-5. · 1.85 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We evaluated the use of positron emission tomography (PET) with fluorine-18-labeled fluoro-2-deoxy-d-glucose (FDG) in follow-up study after radiation therapy in patients with uterine cervical carcinoma.
Thirty-two studies in 25 patients were reviewed. Twenty patients were treated with external beam irradiation and intracavitary brachytherapy, and five with irradiation following initial surgery. Time from initial treatment to FDG-PET was 23.3 (5.2-88.0) months. Rationale for FDG-PET was the presence of symptoms in 6 patients, abnormal serum tumor marker values in 13, abnormal lesions on other diagnostic imaging modalities in 19, and patient request in 2. On visualization of a lesion, the maximum standardized uptake value (maxSUV) of the lesion was calculated, and values over 2.0 were classified as FDG-positive. Maximum tumor diameter and tumor volume in the corresponding disease were estimated by computed tomography (CT) or magnetic resonance imaging (MRI).
Sensitivity and specificity of FDG-PET in the detection of recurrent disease were 91.5% (43/47) and 57.1% (4/7), respectively. Four false-negative findings were seen for small lung metastases having a volume less than 1 cm3. Three false-positive cases were a localized pneumonitis, a benign pubic bone fracture, and a fibrosis after interstitial brachytherapy. Sensitivity for extrapelvic lymph node metastases was extremely high (100%); in contrast, sensitivity and specificity for lung and bone lesions were 75.0% (12/16) and 33.3% (1/3), respectively. Regarding tumor volume measurement, good correlation between maxSUV on FDG-PET and tumor volume was obtained (lung metastases, P = 0.03; extrapelvic nodes, P < 0.0001). Within this study, all corresponding lesions over 1 cm3 showed a maxSUV value greater than 2.0.
FDG-PET is a useful tool for the detection of extrapelvic lesions during the follow-up period after radiation therapy for cervical cancer. This study suggests that FDG uptake is associated with tumor volume, and FDG-PET has limitations in the detection of lesions less than 1 cm3 or microscopic disease. Careful diagnostic agreement between PET and CT/MRI for positive but benign lesions, such as inflammation and bone fracture, remains important.
Gynecologic Oncology 04/2006; 100(3):601-7. · 3.89 Impact Factor
-
Tetsuo Akimoto,
Kazuto Ito,
Jun-ichi Saitoh,
Shin-ei Noda,
Koichi Harashima,
Hideyuki Sakurai, Yuko Nakayama,
Takumi Yamamoto,
Kazuhiro Suzuki,
Takashi Nakano,
Hideo Niibe
[show abstract]
[hide abstract]
ABSTRACT: Several investigations have revealed that the alpha/beta ratio for prostate cancer is atypically low, and that hypofractionation or high-dose-rate (HDR) brachytherapy regimens using appropriate radiation doses may be expected to yield tumor control and late sequelae rates that are better or at least as favorable as those achieved with conventional radiation therapy. In this setting, we attempted treating localized prostate cancer patients with HDR brachytherapy combined with hypofractionated external beam radiation therapy (EBRT). The purpose of this study was to evaluate the feasibility of using this approach, with special emphasis on the relationship between the severity of acute genitourinary (GU) toxicity and the urethral dose calculated from the dose-volume histogram (DVH) of HDR brachytherapy.
Between September 2000 and December 2003, 70 patients with localized prostate cancer were treated by iridium-192 HDR brachytherapy combined with hypofractionated EBRT at the Gunma University Hospital. Hypofractionated EBRT was administered in fraction doses of 3 Gy, three times per week; a total dose of 51 Gy was delivered to the prostate gland and the seminal vesicles using the four-field technique. No elective pelvic irradiation was performed. After the completion of EBRT, all the patients additionally received transrectal ultrasonography (TRUS)-guided HDR brachytherapy. The fraction size and the number of fractions in HDR brachytherapy were prospectively changed, whereas the total radiation dose for EBRT was fixed at 51 Gy. The fractionation in HDR brachytherapy was as follows: 5 Gy x 5, 7 Gy x 3, 9 Gy x 2, administered twice per day, although the biologic effective dose (BED) for HDR brachytherapy combined with EBRT, assuming that the alpha/beta ratio is 3, was almost equal to 138 in each fractionation group. The planning target volume was defined as the prostate gland with 5-mm margin all around, and the planning was conducted based on computed tomography images. The number of patients in each fractionation group was as follows: 13 in the 5-Gy group; 19 in the 7-Gy group, and 38 in the 9-Gy group. The tumor stage was T1 in 10 patients, T2 in 36 patients, and T3 in 24 patients. The Gleason score was 2-6 in 11 patients, 7 in 34 patients, and 8-10 in 25 patients. Androgen ablation was performed in all the patients. The median follow-up duration was 14 months (range 3-42 months). The toxicities were graded based on the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer toxicity criteria.
The main symptoms of acute GU toxicity were dysuria and increase in urinary frequency or nocturia. The grade distribution of acute GU toxicity in the patients was as follows: Grade 0-1, 39 patients (56%), and Grade 2-4, 31 patients (44%). One patient who developed acute urinary obstruction was classified as having Grade 4 toxicity. Comparison of the distribution of the grade of acute GU toxicity among the different fractionation groups revealed no statistically significant differences among the groups. The urethral dose in HDR brachytherapy was evaluated using the following DVH parameters: V30 (percentage of the urethral volume receiving 30% of the prescribed radiation dose), V80, V90, V100, V110, V120, V130, and V150. The V30-110 values in the patients with Grade 2-4 acute GU toxicity were significantly higher than those in patients with Grade 0-1 toxicity. On the other hand, there were no significant differences in the V120-150 values between patients with Grade 0-1 and Grade 2-4 toxicity. Regarding the influence of the number of needles implanted for the radiation therapy, patients with 11 needles or less showed a significantly higher incidence of Grade 2-4 acute GU toxicity compared with those with 12 needles or more (p < 0.05).
It was concluded that HDR brachytherapy combined with hypofractionated EBRT is feasible for localized prostate cancer when considered from the viewpoint of acute toxicity. Increase in the fraction dose or reduction in the number of fractions in HDR brachytherapy did not affect the severity of acute GU toxicity, and the volume of urethra receiving an equal or lower radiation dose than the prescribed dose was more closely associated with the grade severity of acute GU toxicity than that receiving a higher than the prescribed dose.
International Journal of Radiation OncologyBiologyPhysics 10/2005; 63(2):463-71. · 4.11 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: There are great differences between treatment methods for early-stage esophageal cancer in institutions. Radiation therapy has been considered to be an effective modality as organ-preserving treatment of the disease. The aim of this study is to assess the effect and limitation of radiation therapy on patients with early esophageal cancer.
The subjects were 38 patients with stage I (T1N0M0) squamous cell carcinoma of the esophagus who had received definitive radiation therapy alone. Eleven tumors were assessed within the mucosal layer, whereas 27 tumors showed submucosal invasion by examination using endoscopic ultrasound. All patients were treated with more than 60 Gy using a conventional daily fractionation dose at 2 Gy. An additional boost with brachytherapy was performed for 20 patients, and the prescribed doses were 10 Gy (5 Gy x 2 times) with low dose rate (8 patients) and 9 Gy (3 Gy x 3 times) with high dose rate (12 patients). Outcomes and prognostic factors, including the efficacy of intraluminal brachytherapy, were investigated.
The cause-specific survival rate and the local control rate at 5 years were 82.6% and 86.3%, respectively. Recurrences were noted in 8 patients with submucosal cancer, but no recurrence was observed in patients with mucosal cancer. In the present study, tumor length was a statistically significant prognostic factor for cause-specific survival (P = 0.018) and tumor depth tended toward statistical significance (P = 0.073). In 27 patients with submucosal cancer, the tumor length was also statistically significant for the survival (P = 0.032). The 5-year cause-specific survival rates for the short tumor group and the long tumor group were 85.7% and 55.6%, respectively. On the other hand, the use of intraluminal brachytherapy had no significant effect on patient survival.
Radiation therapy is very effective for early esophageal squamous cell carcinoma with tumor length less than 5 cm, but other treatment modalities, including chemoradiotherapy especially for inoperable patients, should be considered for submucosal cancer with a tumor length of 5 cm or more.
Journal of Clinical Gastroenterology 08/2005; 39(6):495-500. · 3.16 Impact Factor
-
Hideyuki Sakurai,
Norio Mitsuhashi,
Koichi Harashima,
Hiroyuki Muramatsu,
Hitoshi Ishikawa,
Yoshizumi Kitamoto,
Yoshiyuki Suzuki,
Jun-ich Saitoh,
Tetsuo Nonaka,
Tetsuo Akimoto, Yuko Nakayama,
Masatoshi Hasegawa,
Takashi Nakano
[show abstract]
[hide abstract]
ABSTRACT: The aim of the study is to develop high-dose-rate (HDR) conformal interstitial brachytherapy by means of combined CT-fluoroscopy guidance with CT-based treatment planning for locally recurrent rectal carcinoma.
Brachytherapy needle insertion was guided with a helical CT scanner providing continuous fluoroscopy reconstruction. A video monitor placed adjacent to the CT gantry simultaneously allowed the operator to see the process of needle insertion. Final CT images were transferred by an online system to the treatment-planning computer, which reconstructed the implant needles and organ contours. The doses in planning target volume were normalized and geometrically optimized. The patients received a brachytherapy dose at 5 Gy twice daily with a hypofractionated accelerated schedule at a total dose of 30-50 Gy with or without external radiation therapy. Eighteen patients were treated with this procedure.
Ten to thirty-six needles (average, 17.3) were successfully placed to the planning target volume in each patient. The average time for CT fluoroscopy was 357 seconds for each procedure. No accident was seen at needle insertion, but 2 patients developed incomplete peroneal nerve palsy after needle removal, but gradually recovered. CT-based treatment planning was faster and more accurate than projection reconstruction with conventional radiograms. Analysis of the dose volume histogram showed conformal dose distribution to the target, while avoiding normal structures.
CT fluoroscopy guidance ensures safety and increases the accuracy of needle placement in brachytherapy. Conformal high-dose-rate (HDR) interstitial brachytherapy with CT-based treatment planning is a method worth considering for locally recurrent rectal cancer.
Brachytherapy 02/2004; 3(4):222-30. · 1.47 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Optimal timing of the measurement of serum squamous cell carcinoma (SCC) antigen during radiation therapy (RT) and its significance for predicting the response of cervical carcinoma patients as early as possible remain unknown.
Sixty-three patients with SCC of the uterine cervix who received RT only were studied. Patients were treated with a combination of external beam irradiation and high-dose rate intracavitary irradiation. The serum SCC antigen level was measured before, every 2 or 3 weeks during, and 1 or 2 months after RT. Clinical outcome was divided into complete response and incomplete response.
Forty-seven patients (74.6%) had serum SCC antigen levels 1.5 ng/mL (the reference value) before RT. Normalization of serum SCC antigen levels at the end of RT were found to be significantly correlated with complete response in the SCC-positive patients. It was especially noted that in patients with serum SCC levels between 5-30 ng/mL before RT, a > 70% decrease in the serum SCC antigen level at 4 weeks was correlated significantly with complete response. In this group, a significant correlation also was found between a > 70% decrease in serum SCC level at 4 weeks and the normalization of SCC at the end of RT.
The current study data suggest that the serum SCC antigen level not only before, but also during and at the end of RT can predict the response of patients with cervical carcinoma and help in identifying those patients who are at high risk of local recurrence and/or distant metastasis.
Cancer 07/2003; 97(12):3114-20. · 4.77 Impact Factor
-
Yoshihiro Saito,
Norio Mitsuhashi,
Kazushige Hayakawa, Yuko Nakayama,
Tomoko Kazumoto,
Masaya Furuta,
Michitaka Yamakawa,
Tetsuo Akimoto,
Hideyuki Sakurai,
Takeo Takahashi,
Hideo Niibe
[show abstract]
[hide abstract]
ABSTRACT: BackgroundSerum carcinoembryonic antigen (CEA) and serum squamous cell carcinoma antigen (SCC Ag) levels have been reported to be useful
as prognostic factors, indicators of clinical response, and predictors for recurrence in patients with lung cancer treated
by surgery or chemotherapy. We investigated whether pretreatment serum CEA and SCC Ag levels were useful as independent prognostic
factors in patients with stage I to III non-small cell lung cancer who were treated with radiation therapy alone.
MethodsThe serum CEA and SCC Ag levels were measured in 158 and 47 patients, respectively, before radiation therapy. Serum CEA and
SCC Ag levels were measured by sandwich radioimmunoassay using the CEA-RIA (radioimmunoassay) kit and the SCC-RIA kit.
ResultsSerum CEA and SCC Ag levels were above reference values in 19% and 30% of the patients, respectively. The 5-year survival
rates were significantly better for patients with a nagative SCC Ag result than for those with positive SCC Ag levels (P=0.0001), though no significant difference in survival rates was seen by CEA positivity (P=0.25). SCC Ag positivity (P=0.0006) and stage (P=0.04) were the important prognostic factors, as determined by multivariate analyses.
ConclusionPretreatment serum SCC Ag level may be useful as an independent prognostic factor in patients with stage I to III non-small
cell lung cancer who are treated with radiation therapy alone.
International Journal of Clinical Oncology 04/1998; 3(1):27-30. · 1.41 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: BackgroundFrom 1976 through 1989, 46 patients with stage IIIB non-small cell lung cancer (NSCLC) without malignant effusion were treated
with definitive radiation therapy (RT) at Gunma University Hospital.
MethodsAll patients were treated with 10 MV x-rays using antero posterior parallel opposed fields. The total dose ranged from 60
Gy to 70 Gy (mean dose; 66 Gy) with once daily standard fractionation.
ResultsThe actuarial two and five-year survival rates of the entire group were 22% and 10% respectively with a median survival time
(MST) of 10 months. The survival of 18 patients with stage NO-2 disease was significantly better than the 28 patients with
stage N3 disease (MST 21 versus 9 months;P<0.05). There were no significant differences in survival based on age and sex. However, there was a borderline difference
in survival rates between patients with a performance status of 0–1 and those with a status of 2–3 (P=0.06). Three patients with squamous cell carcinoma were alive after 5 years and were without disease progression. No patients
with non-squamous cell carcinoma were free of disease after 5 years.
ConclusionThese results provide support for the use of definitive RT to manage those patients with limited stage IIIB squamous cell
carcinoma not extending to N3 stage.
International Journal of Clinical Oncology 04/1996; 1(1):13-17. · 1.41 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Japanese randomized trials showed that there was a significant impact on survival from stage I adenocarcinoma (AD) of the lung by adjuvant chemotherapy with uracil-tegaful after complete resection but there was no effect for patients with squamous cell carcinoma (SQ). The purpose of this study was to examine the correlation of tumor histology and clinical outcome of radiation therapy (RT) for stage I non-small-cell lung cancer (NSCLC) and to consider the necessity of adjuvant chemotherapy after RT for these patients. The subjects were 83 patients, 54 with SQ and 29 with AD; they had received definitive RT with the total dose ranging from 60 to 80 Gy with conventional fractionation at a daily dose of 2 Gy. The differences between SQ and AD with respect to survival and recurrence pattern were investigated. The 5-year overall survival and cause-specific survival rates were 26.5% and 49.1%, respectively. No difference in survival was observed between SQ and AD patients, and the recurrence rates were almost identical (44% for SQ and 45% for AD). However, the 5-year primary control rate of SQ was significantly poorer than that of AD (SQ: 61.5%; AD: 87.6%; p = 0.03). Conversely, the 5-year metastasis-free survival rate of SQ was significantly better than that of AD (SQ: 88.2%; AD: 53.0%; p = 0.005). The different failure pattern, according to tumor histology, indicates that taking into consideration the difference in their clinical behaviors would also be important for planning RT and surgery for early lung cancer.
Beiträge zur Klinik der Tuberkulose 184(6):347-53. · 1.90 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: From 1976 through 1985, 142 patients with Stage I–III epidermoid carcinoma of the lung received radiation therapy (RT) with total doses of 60–80 Gy at Gunma University Hospital. Patients with performance status (PS) 0–1 had an actuarial survival of 47% and 24% at 2 and 5 years, compared with 27% and 7% in those with PS 2, and 10% in PS 3 (p < 0.01). The actuarial survival rates for stage I, II, IIIA and IIIB were 75%, 44%, 32% and 19% at two years, and 31%, 22%, 13% and 10% at five years, repectively (p < 0.05). At five years, 26% of the patients with tumors less than 5 cm in diameter had survived, in contrast to 11% in those with tumors greater than 5 cm in diamter (p < 0.001). Patients given a total dose of 80 Gy or over had a lower long-term survival rate than those given a total dose of 60–79 Gy. Four patients irradiated over 80 Gy at the proximal portion of bronchi developed severe bronchial stenotic changes resulting in pulmonary insufficiency and died of intercurrent pulmonary disease without evidence of recurrence of the carcinoma at one or three years after RT. Patients with the primary tumors located in the upper lobes or the superior segment of the lower lobes had an excellent prognosis (p < 0.05). Stage N3 disease or malignant effusion revealed unfavorable prognostic factors. For age, sex and histologic subtypes, there were no significant differences in survival. For the five year survivors, the total irradiated doses were 60–70 Gy, and the size of the radiation field given over dose of 40 Gy was mostly 100 cm2 or less. In our results, the patients with epidermoid carcinoma of the lung without distant metastasis or malignant effusion were expected to be offered a realistic probability of long-term survival by RT alone.
Lung Cancer.
-
[show abstract]
[hide abstract]
ABSTRACT: Patients with brain metastases of non-small cell lung cancer (NSCLC) have a poor prognosis, so chemotherapy and best-supportive care are typically pursued as initial treatments.
A 52-year-old man presented with symptoms of disorientation and disturbed consciousness as a result of multiple brain metastases. A histopathological examination revealed that the primary tumor was a large cell carcinoma located in the left upper lung. Whole brain irradiation (WBI) with a total dose of 50 Gy was immediately started. Since the brain tumors were successfully controlled, irradiation of the primary lung lesion with a total dose of 60 Gy was initiated 6 months after the WBI. Afterward, the patient was clinically free from lung cancer, but other cancers developed in the cecum and appendix and were surgically removed. He survived for more than 8 years after the WBI but eventually died of respiratory insufficiency caused by multiple lung metastases. The autopsy findings indicated that the lung lesions were metastatic adenocarcinomas from the appendiceal cancer, and the patient had remained disease-free from lung cancer.
In view of the possibility of long-term survival in patients with stage IV NSCLC and brain metastasis, especially those with only intracranial metastases, careful consideration is be needed in the selection of treatment options.
Anticancer research 26(1B):605-9. · 1.73 Impact Factor
